Selections And Clinical Comparative Study Of Different Surgical Pathways For Parotid Tumors

Objective.To compare the advantages with disadvantages of different surgical pathways by the research of four goups of parotid surgical paths.Method.All 218 cases which were conceived by retrospective investigation were patients who visited the 1^st Affiliated Hospital to the Medical college of Zhe Jiang University during Feb 2004 to Feb 2008.And we lost 12 patients during postoperative follow-up.206 cases were retrospectively divided into 4 groups.Ⅰ(61)'S'shape incision and reconstruction by cutaneous flap,Ⅱ(25)'S'shape incision and reconstruction by sternocleidomastoid flap,Ⅲ(79)modified'S'shape incision and parotid fascia,Ⅳ(41) minimal incision and parotid fascia.All patients were followed up for 1 year.We observed the postoperative incision scars,temporary facial paralysis, salivary leakage,Frey's syndrome,numbness around the ear and the satisfaction survey of postoperative appearance.Results.127(62%) patients'pathological reports were pleomorphic adenoma,57(28 %) were Warthin's tumor,11(5%) basal cell adenoma,5(2%) Oxyphilic adenoma, 3(1%) myoepithelioma,1 myoepithelioma,1 cystoadenoma,1 patient had 2 kinds of tumor coexisting pleomorphic adenoma and Warthin's tumor.The male-to-female ratio for 127 pleomorphic adenoma was 1:1.5,The male-to-female ratio for 57 Wathin's tumor was 7:1.The difference of male-to-female ratios between pleomorphic adenoma and Wathin's tumor was significant(p＜0.001).The mean age of pleomorphic adenoma was 42 years,which is significantly younger than that(59years) of Wathin's tumor.Only 1 patient suffered bilateral pleomorphic adenoma while 6 patients had bilateral Wathin's tumor,which means the incidence of bilateral Wathin's tumor was significantly higher than that of bilateral pleomorphic adenoma.In 57 Wathin's tumor, 49 were smokers and 28 were hypertension which were significantly more than pleomorphic adenoma respectively.46(22%) patients subjectively reported symptoms of Frey's syndrome.32(15%) patients developed transient facial paralysis within 1 week after surgery,30 patients'symptoms disappeared during 6 months'follow-up. Other complications were numbness around the skin of ear(20%),salivary leakage(5%), haematoma(1%),hemorrhage(1%);infection(1%),et al.The incidence of Frey's syndrome forⅠwas 42%(26/61),Ⅱ31%(8/25),Ⅲ10%(8/79),Ⅳ7% (3/41 ).The incidence of transient facial paralysis forⅠwas 18%(11/61),Ⅱ组20 %(5/25 ),Ⅲ15%(12/79),Ⅳ10%(4/41).Patients in groupⅣwere most satisfied with the postoperative appearance.Conclusion.Surgeons can choose different surgical incisions and pathways according to the aesthetic requirements from patients,the size and extent of tumor.Parotid fascia suturing is a simple and efficient way for preventing Frey's syndrome. Sternocleidomastoid flap is effective for repairing the soft tissue defect.Therefore,we suggested the combination of parotid fascia suturing and Sternocleidomastoid flap, which needs more research.Generally,minimal incision and parotid facsia takes both aesthetic effect and preventing Frey's syndrome and other complications into consideration,thus,is a practical surgical pathway.